Effect of Combined Mouth Closure and Chin Lift on Upper Airway Dimensions during Routine Magnetic Resonance Imaging in Pediatric Patients Sedated with Propofol

Reber, A.; Wetzel, Stephan G.; Schnabel, K; Bongartz, Georg; Frei, Franz J.

doi:10.1097/00000542-199906000-00018

Cited by 72 publications

(38 citation statements)

References 25 publications

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“…This explanation is supported by PICKERING and BEARDSMORE [18] who showed that when the chin lift manoeuvre was performed with an almost closed mouth in children with adenotonsillar hypertrophy, there was greater resistance to nasal breathing, caused by the adenoids. However, in a previous study it was demonstrated that in healthy children without adenotonsillar hypertrophy, chin lift is an effective manoeuvre to insure an open airway during propofol anaesthesia [19]. Chin lift widened the airway diameter anterioposteriorly mainly at the area of the epiglottis and transversally at the soft palate [19].…”

Section: Discussionmentioning

confidence: 98%

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Effect of airway opening manoeuvres on thoraco-abdominal asynchrony in anaesthetized children

Reber¹,

Bobbià²,

Hammer³

et al. 2001

Eur Respir J

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Thoraco-abdominal asynchrony is frequently encountered during inhalation anaesthesia in children with adenotonsillar hypertrophy causing an upper airway obstruction. The study goal was to evaluate the impact of different airway opening manoeuvres on thoraco-abdominal asynchrony as a measure of airway obstruction.Thirty anaesthetized children (aged 2 -8 yrs; sevoflurane 3% in 50% oxygen/nitrous oxide) were studied prior to elective adenotonsillectomy using respiratory inductance plethysmography to record ribcage and abdominal wave forms as a basis for calculation of the phase angle. Five airway situations were compared: 1) baseline (unsupported mandible); 2) chin lift; 3) chin lift combined with continuous positive airway pressure of 10 cmH 2 O; 4) jaw thrust; and 5) jaw thrust combined with continuous positive airway pressure of 10 cmH 2 O.Three children had complete upper airway obstruction at baseline and were excluded from the study. With chin lift, thoraco-abdominal asynchrony improved in three patients, worsened in three patients and was unchanged in 21 patients. Additional continuous positive airway pressure during chin lift did not markedly reduce thoracoabdominal asynchrony (phase angle 89¡43u, p~0.33). Jaw thrust resulted in a significant decrease of the phase angle (from 106¡53u at baseline to 65¡49u, pv0.01); when combined with continuous positive airway pressure, no further effect on thoracoabdominal asynchrony was found (72¡44u).In anaesthetized children with adenotonsillar hypertrophy, airway opening manoeuvres have distinct effects on thoraco-abdominal asynchrony. Delivery of continuous positive airway pressure and jaw thrust can be the first airway opening manoeuvres to improve breathing patterns. Chin lift without additional continuous positive airway pressure should be used with caution in these patients because it may convert partial into almost complete airway obstruction.

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Section: Discussionmentioning

confidence: 98%

“…However, in a previous study it was demonstrated that in healthy children without adenotonsillar hypertrophy, chin lift is an effective manoeuvre to insure an open airway during propofol anaesthesia [19]. Chin lift widened the airway diameter anterioposteriorly mainly at the area of the epiglottis and transversally at the soft palate [19].…”

Section: Discussionmentioning

confidence: 98%

Effect of airway opening manoeuvres on thoraco-abdominal asynchrony in anaesthetized children

Reber¹,

Bobbià²,

Hammer³

et al. 2001

Eur Respir J

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“…Different mechanisms may explain the observed increases in TGV with blood loss. The thoracic blood volume can considerably decrease as a result of acute hemorrhage (30). This decrease can contribute to the increase in TGV by the replacement of blood by gas in the thoracic cavity.…”

Section: Discussionmentioning

confidence: 99%

Acute hemorrhagic shock decreases airway resistance in anesthetized rat

Bayat

Albu

Layachi

et al. 2011

Journal of Applied Physiology

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Bayat S, Albu G, Layachi S, Portier F, Fathi M, Peták F, Habre W. Acute hemorrhagic shock decreases airway resistance in anesthetized rat. J Appl Physiol 111: 458 -464, 2011. First published May 19, 2011 doi:10.1152/japplphysiol.00024.2011We studied the relation between changes in pulmonary and systemic hemodynamics to those in the airway resistance, respiratory tissue mechanics, and thoracic gas volume (TGV) following acute hemorrhage and blood reinfusion in rats. Forced oscillation technique was used to measure airway resistance (Raw), respiratory tissue damping, and elastance at baseline and after stepwise 1-ml blood withdrawals up to 5 ml total, followed by stepwise reinfusion up to full restoration. Mean systemic (Pam) and pulmonary arterial pressures and suprarenal aortic blood flow were measured at each step. In supplemental animals, plethysmographic TGV, Pam, and respiratory mechanics measurements were performed. Blood volume loss (BVL) led to proportional decreases in Raw (66.5 Ϯ 8.8 vs. 44.8 Ϯ 9.0 cmH 2O·s·l Ϫ1 with 5 ml, P Ͻ 0.001), Pam, and aortic blood flow. In contrast, tissue damping increased significantly (1,070 Ϯ 91 vs. 1,235 Ϯ 105 cmH 2O/l, P ϭ 0.009 with 5 ml BVL), whereas tissue elastance did not change significantly. TGV significantly increased with acute BVL (3.7 Ϯ 0.2 vs. 4.2 Ϯ 0.2 ml, P ϭ 0.01). Stepwise reinfusions produced opposite changes in the above parameters, with Raw reaching a higher value than baseline (P ϭ 0.001) upon full volume restoration. Both adrenalin (P ϭ 0.015) and noradrenalin levels were elevated (P ϭ 0.010) after 5-ml blood withdrawal. Our data suggest that the decreases in Raw following BVL may be attributed to the following: 1) an increased TGV enhancing airway parenchymal tethering forces; and 2) an increase in circulating catecholamines. The apparent beneficial effect of a reduction in Raw in acute hemorrhagic shock is counteracted by an increase in dead space and the appearance of peripheral mechanical heterogeneities due to de-recruitment of the pulmonary vasculature.

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“…18 In addition, chin lift, thrusting the jaw forward or extension of the head also widens the oropharyngeal space. 19,20 In our patients, during the manual in-line position, it was often difficult to advance the fibrescope through the space between the epiglottis and posterior pharyngeal wall, and it was possible to insert the fibrescope into the trachea within two minutes in only eight of 20 patients.…”

Section: Discussionmentioning

confidence: 82%

Intubating laryngeal mask for fibreoptic intubation — particularly useful during neck stabilization

Eguchi

Murao

Niitsu

et al. 2000

Can J Anesth/J Can Anesth

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Purpose: To assess the ease of fibrescope-assisted tracheal intubation while the patient's head and neck were placed in the neutral or the manual in-line position, and to determine if the intubating laryngeal mask facilitated fibreoptic intubation in these positions. Methods:In 84 patients, the patient's head and neck were placed in the neutral position (pillow placed under occiput), and in another 40 patients the head and neck were stabilized by the manual in-line method (no pillows under occiput). In both groups, after induction of anesthesia with 2.0 -2.5 mg·kg -1 propofol, 50 -100 µg fentanyl and 1.0 mg·kg -1 vecuronium, patients were allocated randomly into two groups: in Group C tracheal intubation was attempted using only a fibrescope, whereas in Group L fibreoptic intubation through the intubating laryngeal mask was attempted.Results: In group C the success rate of fibreoptic tracheal intubation within two minutes was higher in the neutral position (31 of 42 patients (73%)) than in the manual in-line position (8 of 20 patients (40%)). In contrast, in group L the success rate was similar between the two positions. Tracheal intubation was easier in group L than in group C (P < 0.01 or 0.001) and the time for intubation was shorter in group L than in group C in both head and neck positions.Conclusions: Fibreoptic tracheal intubation was more difficult in the manual in-line position than in the neutral position. The intubating laryngeal mask facilitated fibreoptic intubation in both positions.Objectif : Évaluer la facilité de l'intubation endotrachéale fibroscopique alors que la tête et le cou du patient sont en position neutre ou en position en ligne manuelle. Déterminer aussi si le masque laryngé d'intubation facilite l'intubation fibroscopique dans ces positions.Méthode : Chez 84 patients, la tête et le cou ont été placés en position neutre (un oreiller sous l'occiput) et chez 40 autres patients, la tête et le cou ont été stabilisés manuellement par la méthode en ligne (sans oreiller). Après l'induction de l'anesthésie avec 2,0 -2,5 mg·kg -1 de propofol, 50 -100 µg de fentanyl et 1,0 mg·kg -1 de vécuronium, les patients ont été répartis au hasard en deux groupes : le groupe C où l'intubation endotrachéale a été tentée en utilisant seulement le fibroscope, tandis que dans le groupe L, l'intubation fibroscopique a été réa-lisée au travers du masque laryngé d'intubation.Résultats : Dans le groupe C, le taux de succès de l'intubation endotrachéale fibroscopique, réalisée en moins de deux minutes, a été plus élevé chez les patients en position neutre (31 des 42 patients ou 73 %) que chez les patients en ligne (8 des 20 patients ou 40 %). Par ailleurs, dans le groupe L, le taux de succès a été similaire pour les deux positions. L'intubation endotrachéale a été plus facile dans le groupe L que dans le groupe C (P < 0,01 ou 0,001) et le temps nécessaire à l'intubation a été plus court dans le groupe L que dans le groupe C pour les deux positions.Conclusion : L'intubation endotrachéale fibroscopique a été plus dif...

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Effect of Combined Mouth Closure and Chin Lift on Upper Airway Dimensions during Routine Magnetic Resonance Imaging in Pediatric Patients Sedated with Propofol

Cited by 72 publications

References 25 publications

Effect of airway opening manoeuvres on thoraco-abdominal asynchrony in anaesthetized children

Effect of airway opening manoeuvres on thoraco-abdominal asynchrony in anaesthetized children

Acute hemorrhagic shock decreases airway resistance in anesthetized rat

Intubating laryngeal mask for fibreoptic intubation — particularly useful during neck stabilization

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